- IQVIA (Miami, FL)
- **Patient Support Medical Claims Processing Representative ** _Contract Remote Role - Location (Open to Remote US)_ As the only global provider of commercial ... are looking for a 100% remote (work from home-WFH) contact **Patient Support Medical Claims Processing Representative ** to join our team. In this position, you… more
- Molina Healthcare (Orlando, FL)
- JOB DESCRIPTION Job SummaryProvides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching ... pharmacy strategy for optimization of medication related health care... prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any… more
- Highmark Health (Tallahassee, FL)
- …coordination of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + ... **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree +… more
- CVS Health (Tallahassee, FL)
- …to assist members in understanding components of the Aetna products including claims , accumulators, usage and balances and cost sharing. Provides support to the ... deliver successful cost-saving transitions of care. A proven background in medical/ pharmacy benefits, particularly as these relate to infused specialty medications.… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …Specialist is responsible for managing and identifying a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing ... RESPONSIBILITIES + Manage and identify a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement...environment PHYSICAL DEMANDS The physical demands described here are representative of those that should be met by an… more
- CVS Health (Largo, FL)
- …client satisfaction, retention, and engagement by serving as a trusted onsite representative to our public sector client. This field-based role centers on delivering ... in-person support across multiple worksites, handling complex benefit and claims inquiries, and providing education during open enrollment and health-related… more
- Prime Therapeutics (Tallahassee, FL)
- …experience, preferably leveraging AI + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... levels of leadership within the organization, acting as a representative of the broader Financial Systems team + Provide...we are a different kind of PBM. We're reimagining pharmacy solutions to provide the care we would want… more